Gliederung

Objective: Because of their space occupying effect, spinal ependymomas may become symptomatic by causing severe neurological deficits. The gold standard of treatment is the total removal of the tumor, however, extended dorsal approaches with bilateral multilevel laminectomies may cause late complications due to iatrogenic destruction of posterolateral elements of the spinal column.

Methods: During a 5-year period between January 2001 and December 2005, 234 patients with intraspinal-intradural tumors and vascular lesions were operated in our department. After preoperative planning of surgery, the individual pathoanatomical situation was taken into consideration, where 187 patients were treated with a unilateral approach with single- or multilevel hemilaminectomy. In 71 patients, the space occupying lesion could be removed through multiple interlaminary keyhole fenestrations, reducing surgical traumatization of the musculo-skeletal structures.

Results: Of the 71 patients, 28 had intraspinal ependymomas; these tumors were located in the cervical spinal cord in 8 cases, in the thoracic section in 6 cases l and in the lumbar spinal cord in 14 cases. In 7 cases 1 unilateral fenestration was carried out; in 10 cases 2 fenestrations, in 5 cases 3, neurological impairment and 3 patients it was moderate. 7 patients showed clinical improvement, 17 patients were unchanged after the operation. Postoperative MR imaging demonstrated complete tumor removal in 21 patients, incomplete resection in 6 cases and in 1 case partial tumor reduction. No spinal instabilities were observed during a follow-up period of up to 5 years.